BC’s independent online magazine, The Tyee, reports the obvious: the province’s drug supply-related death toll is a seemingly unstoppable seven-year-old wildfire. And the people with power (as in: the BC NDPs, the Ministry of Health, and our federal Canadian government, to name a few) are like poorly trained volunteer fire-fighters trying to extinguish the blaze with their garden hoses, watering cans, hydrating facial mists, and other erroneous (also: harmful) interventions.
It’s almost like they are watching us burn to death. Or maybe they can’t see us. But seven years into this poisoning epidemic, it’s difficult (if not impossible) to claim ignorance — especially when the BC cornoner’s office reports the drug toxicity death data.
Let’s review: Back in 2016, BC announced a public health emergency in response to (what they saw as) a succession of overdose deaths caused by contaminated illegal drugs. The opioid fentanyl, reported to be ‘one hundred times more potent than morphine,’ was named the primary culprit. And the pitch forks came out.
Fentanyl — a narcotic anaesthetic available mostly in hospital surgery settings — has since become a household name. Although some drug consumers recall (illegally) tampering with controlled prescription fentanyl patches prior to BC’s so-called overdose crisis, fentanyl was comparatively unknown prior to 2015/2016. Some called for a complete (prescription) fentanyl boycott. But it wasn’t fentanyl gel patches that were killing drug consumers; instead, consumption of increasingly potent (unstable/unregulated) fentanyl analogues had contaminated our street supply (replacing safer alternatives like heroin, for example).
What is an analogue? According to chemistry and pharmacology peeps, analogues share similarities with existing drug molecules. They are copies of the original design, sharing structural and/or psychoactive similarities. This means that the black-market fentanyl is not the same fentanyl we use in hospitals. Fentanyl analogues are unregulated, illegal substances, and their production is driven by the (criminal) drug trafficking industry, and those who are financially incentivized to police it.
In addition to declaring a public health emergency, BC’s response to the drug poisoning epidemic included their version of a (controversial) ‘safe supply’ program.
Some conservative critics argue that safe supply — made available since the 2020 COVID-19 outbreak to (very few) folks — is helping escalate the death toll. But that is a gross misunderstanding of the province’s prescription safe supply program, as well as the drug toxicity crisis as a whole.
Why isn’t BC’s safe supply program reducing drug toxicity deaths?
Most people dying from drug toxicity today are people who are not opioid dependent, meaning they lack the tolerance required to survive ingestion of highly potent fentanyl analogues. According to the coroner, these folks are also mostly male, aged thirty to fifty-nine years old. Many are working in trades, and dying in private residences.
These folks were probably not diagnosed with opioid use disorders prior to their deaths. This means they were unlikely targets for life-saving healthcare/harm reduction interventions, like safe supply, opiate agonist treatment (OAT) and safe consumption sites. They are also unlikely to frequent detox and residential treatment programs.
And since drugs like crack-cocaine are also testing positive for fentanyl analogues and other contaminants, it’s likely that some were not intentional consumers of street opioids.
And yet, the provincial response prioritizes increasing treatment supports, also known as ‘adding beds.’ But why, how, who or where is the budget increase being allocated? Details are vague, at best.
One thing is certain: the provincial response is not aligned with the coroner’s data.
Safe supply: Let’s review
According to the Canadian Association of People Who Use Drugs (CAPUD), safe supply ‘refers to a legal and regulated supply of drugs with mind/body altering properties that traditionally have been accessible only through the illicit drug market.’
Safe supply doesn’t mean taking a couple controlled opioid medications and making them available to a very limited group of folks who are likely already connected with substance use services, including OAT treatment.
Hydromorphone and slow-release oral morphine are two alternatives that were made available by the government-issued safe supply program. Are they safe? Well, they are regulated, and their contents are known — just like any other prescription or over-the-counter med (like Prozac or Advil). But they aren’t legal/regulated and structurally/functionally similar versions of toxic street opioids.
In order for folks to switch from street dope to a safer prescription alternative, the alternative should be as similar as possible (or better). This means that drug-generated euphoria should also be comparable (or better), and any dopesickness MUST be under control (as in, vanquished).
The situation is more complex today, however, because the supply is even more contaminated. For the past three or more years, we’ve been dealing with toxic benzodiazepine analogues, which are not responsive to Narcan, and known to cause blackouts and other serious health complications.
Worse, there are now reports that some street drug samples are testing positive for the animal tranquilizer, xylazine.
Let’s be clear: Antidotes for benzo-analogue-adulterated/tranquilizer-tainted street dope do not exist. There are no cures or medical substitutes (as far as we know).
Where’s the hope?
BC’s substance use services are in desperate need of a facelift. Or a re-structuring. Or maybe just tear the whole thing down, and start again. And put folks with lived/living experience in the middle, because we are the experts of our own care. Do not re-design services without our input.
Add some ‘beds,’ sure (beds are helpful when a drug consumer wants a break, or just needs to make the best of a bad healthcare situation). But safe/private/affordable housing is a basic survival right. And we can’t get/stay “well” without homes of our own.
So, maybe move ‘beds’ (full-stop) down on the priorities list — at least until we can build regulated healthcare solutions that are proven to vanquish suffering and improve lives.
To stop people from dying? Focus on the supply. Prioritize research and innovation. Legalize & regulate.